APPROACHES TO RATIONING DRUGS IN HOSPITALS - AN AUSTRALIAN PERSPECTIVE

The increasing need to consider rationing strategies within the health care environment is being driven by pressures such as the development of new medical technologies, the aging population, patient awareness a nd expectations, healthcare professionals' appetite for new treatments , and government restrictions on healthcare costs. Solutions to these pressures will need to be sought urgently to avoid a situation in whic h quality of healthcare is affordable only for the wealthy. The fundam ental principles of equity and fairness will need to be applied univer sally if the solutions are to be accepted by the community, patients a nd practitioners. There are several measures that a hospital must have in place before the concept of drug rationing can be contemplated. Th e approach essentially involves ensuring rational drug approval proces ses based on critical review of the available data, coupled with ongoi ng education and audit. Thus, accurate information and clinical budget ing systems, processes which encourage and ensure structural and techn ical efficiencies within the drug use sequence and an effective Drug a nd Therapeutics committee are required to facilitate this approach. To assist with its overriding goals of the quality use of medicines and optimal patient care, the Drug and Therapeutics committee needs to imp lement an effective formulary system, obtain detailed guidelines gover ning drug use within the institution, conduct an ongoing drug utilisat ion review programme, and provide education and training. The move to consider allocative decision making (rationing) will become increasing ly necessary as limits on structural and technical efficiency measures are reached. An institution will then need to decide whether to treat a particular group of patients, or provide a certain form of treatmen t. improved methods for community consultation need to be explored and there must be a partnership between the health provider and the consu mer in enunciating the existence of scarcity, determining priorities a nd ensuring that ethics and equity are not abandoned through this proc ess.